Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: A systematic review and narrative synthesis

Abstract

Introduction Older people with frailty (OPF) can experience reduced quality of care and adverse outcomes due to poorly coordinated and fragmented care, making this patient population a key target group for integrated care. This systematic review explores service user, carer and provider perspectives on integrated care for OPF, and factors perceived to facilitate and hinder implementation, to draw out implications for policy, practice and research. Methods Systematic review and narrative synthesis of qualitative studies identified from MEDLINE, CINAHL, PsycINFO and Social Sciences Citation Index, hand-searching of reference lists and citation tracking of included studies, and review of experts’ online profiles. Quality of included studies was appraised with The Critical Appraisal Skills Programme tool for qualitative research. Results Eighteen studies were included in the synthesis. We identified four themes related to stakeholder perspectives on integrated care for OPF: different preferences for integrated care among service users, system and service organisation components, relational aspects of care and support, and stakeholder perceptions of outcomes. Service users and carers highlighted continuity of care with a professional they could trust, whereas providers emphasised improved coordination of care between providers in different care sectors as key strategies for integrated care. We identified three themes related to factors facilitating and hindering implementation: perceptions of the integrated care intervention and target population, service organisational factors and system level factors influencing implementation. Different stakeholder groups perceived the complexity of care needs of this patient population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as key factors hindering implementation. Providers mainly also highlighted other organisational and system factors perceived to facilitate and hinder implementation of integrated care for OPF. Conclusions Similarities and differences in lay and professional stakeholder perspectives on integrated care for OPF and factors perceived to facilitate and hinder implementation were evident. Findings highlight the importance of addressing organisational and system level components of integrated care and factors influencing implementation for OPF. Greater attention needs to be placed on collaboratively involving service users, carers and providers to improve the co-design and implementation of integrated care programmes for this patient population.

Enhancing primary care support for informal carers: A scoping study with professional stakeholders

“…The Care Act (The Stationary Office, ) is a clear legal framework and places responsibility of addressing carer needs and quality of life on LAs. Implementation towards integrated care is hindered by a lack of continuity and coordination of care and limited involvement of service users and their carers in care decisions (Sadler et al, ).…”

The Over 75 Service: Continuity of Integrated Care for Older People in a United Kingdom Primary Care Setting

“…Relational continuity was established primarily with the practice matrons. In a recent review of integrated care for older people with frailty, it was found that service users and carers placed importance on continuity of care through one-to-one relationships with a care co-ordinator, valuing this relationship to provide information and support and facilitate personalised care [21]. The main facilitators and maintenance factors for relational continuity, in this study, where the accessibility of the matrons via a direct telephone line and their ability to respond quickly when needed.…”

Effectiveness of integrated chronic care interventions for older people with different frailty levels: a systematic review protocol

“…There are a growing number of systematic reviews that have evaluated integrated care interventions for frailty. [20][21][22][23][24] Integrated care has been defined as an organisational approach of coordinating continuous care based on a patient's needs and viewing the patient in a holistic manner. 25 All of the systematic reviews on integrated care have considered older people with different levels of frailty as a single population and did not distinguish by frailty status.…”